Augusto Hasiak Santo

Mortality Profile Related to Systemic Lupus Erythematosus: A Multiple Cause-of-death Analysis

Objective. To analyze the mortality profile related to systemic lupus erythematosus (SLE) in the state of São Paulo, Brazil. Methods. For the 1985–2007 period, we analyzed all death certificates (n = 4815) on which SLE was listed as an underlying (n = 3133) or non-underlying (n = 1682) cause of death. We evaluated sex, age, and the causes of death, comparing the first and last 5 years of the period, as well as determining the observed/expected death ratio (O/E ratio). Results. For SLE as an underlying cause, the mean age at death was 35.77 years (SD 15.12) and the main non-underlying causes of death were renal failure, circulatory system diseases, pneumonia, and septicemia. Over the period, the proportional mention of infectious causes and circulatory system diseases increased, whereas renal diseases decreased. For SLE as a non-underlying cause of death, the most common underlying causes of death were circulatory, respiratory, genitourinary, and digestive system diseases, and certain infections. The overall death O/E ratio was > 1 for renal failure, tuberculosis, septicemia, pneumonia, and digestive system diseases, as well as for circulatory system diseases at < 50 years of age, particularly acute myocardial infarct. Conclusion. Unlike in developed countries, renal failure and infectious diseases are still the most frequent causes of death. The increase in SLE deaths associated with infection, especially pneumonia and septicemia, is worrisome. The judicious use of immunosuppressive therapy together with vigorous treatment of cardiovascular comorbidities is crucial to the successful management of SLE and to improving survival of patients with SLE.

Mortalidade infantil em município da região Centro-Oeste Paulista, Brasil, 1990 a 1992

Abstract Introduction Infant mortality was studied in an urban area of Southeastern Brazil in theperiod from 1990 to 1992 using data from death certificates collected at theregistry office, by the application of methods for obtaining a collective diagno-sis which will assist in the identification and choice of strategies for the controlof local problems.Material and Method The original data were corrected using documental research into health ser-vices and household interviews. Data of the Live Birth Information System(SINASC) was used to study variables such as maternal age and birthweight.The quality of original death certificates was initially analyzed using theamount of information, sensitivity, specificity and Kappa value.Results The global sensitivity for the underlying cause was 78.84% and Kappa 71.32%for the total of causes. One hundred and eighty-nine deaths occurred, 66.15%of them in the neonatal period, (41.28% during the first day of life) and 33.85%in late childhood. The birthweight of 58.28% of deaths was less than 2,500g.The underlying causes of death were studied the by possibility, of their avoid-ance (a method developed by Erica Taucher), by a “reduced” group of causes(utilized in International Collaborative Effort (ICE)), multiple causes statisticsand geographical distribution. It was observed that in the deaths occurring upto 27 days, 22.23% could have been avoided by adequate care during labour,and 20.64% could have been avoided by early diagnosis and early treatment,13.75% by good pregnancy care and only 7.94% were unavoidable. Of thedeaths occurring in late childhood, 12.17% were classified as of avoidablecauses and 4.23% were considered as unavoidable. Using ICE groups, 58.74%died of immaturity or asphyxia, 19.58 of infection and 12.17% from congenitalabnormalities.Conclusions The results suggest that priority be given to obstetrical care at delivery andduring labour and to the pediatric care of low birth weight, among others. Theanalysis using multiple causes statistics shows that 76.05% of the deaths haveunderlying causes related to neonatal disorders and confirms the relationshipwith the weight deficiencies of the newborn. The maternal complications werealso related to weight deficiencies. Great differences were identified in infantmortality rates in urban zones not only restricted to the value of the rates butalso to the diseases responsible for the occurrence of deaths. We therefore con-clude that there is an advantage to be gained in using the four methods, whichare complementary, for studying or planning actions with a view to preventinfant mortality.Infant mortality. Underlying cause of deathunderlying cause of death.

Tendência da mortalidade relacionada à paracoccidioidomicose, Estado de São Paulo, Brasil, 1985 a 2005: estudo usando causas múltiplas de morte

OBJETIVO: Estudar a mortalidade relacionada a paracoccidioidomicose informada em qualquer linha ou parte do atestado medico da declaracao de obito. METODOS: Os dados provieram dos bancos de causas multiplas de morte da Fundacao Sistema Estadual de Analise de Dados (SEADE) de Sao Paulo entre 1985 e 2005. Foram calculados os coeficientes padronizados de mortalidade relacionada a paracoccidioidomicose como causa basica, como causa associada e pelo total de suas mencoes. RESULTADOS: No periodo de 21 anos ocorreram 1 950 obitos, sendo a paracoccidioidomicose a causa basica de morte em 1 164 (59,7%) e uma causa associada de morte em 786 (40,3%). Entre 1985 e 2005 observou-se um declinio do coeficiente de mortalidade pela causa basica de 59,8% e pela causa associada, de 53,0%. O maior numero de obitos ocorreu entre os homens, nas idades mais avancadas, entre lavradores, com tendencia de aumento nos meses de inverno. As principais causas associadas da paracoccidioidomicose como causa basica foram a fibrose pulmonar, as doencas cronicas das vias aereas inferiores e as pneumonias. As neoplasias malignas e a AIDS foram as principais causas basicas estando a paracoccidioidomicose como causa associada. Verificou-se a necessidade de adequar as tabelas de decisao para o processamento automatico de causas de morte nos atestados de obito com a mencao de paracoccidioidomicose. CONCLUSOES: A metodologia das causas multiplas de morte, conjugada com a metodologia tradicional da causa basica, abre novas perspectivas para a pesquisa que visa a ampliar o conhecimento sobre a historia natural da paracoccidioidomicose.

Causas múltiplas de morte relacionadas à tuberculose no Estado de São Paulo, 1998

OBJECTIVES The goal of this paper is to investigate mortality related to tuberculosis in the state of S o Paulo, southeastern Brazil, according to multiple causes of death and their interrelation with other underlying causes. METHODS The study investigated deaths related to tuberculosis that occurred in the state of S o Paulo in 1998. Data were obtained from the Fundação Sistema Estadual de Análise de Dados (State System for Data Analysis Foundation - SEADE) database. Causes of death by clinical forms of TB were coded in block A15-A19, and by its sequelae in category B90, according to the guidelines proposed by the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems. Tabulador de Causas Múltiplas (Multiple Cause Tabulator - TCM) software was used for processing associated causes of death. Statistical analysis included analysis of variance, Students t -distribution, and chi-squared tests. RESULTS TB was the underlying cause of 1,644 deaths, a 4.6/100,000 population mortality rate. Main associated causes were respiratory failure (46,9%), pneumonias (16.5%), other specified symptoms and signs involving circulatory and respiratory systems (13.9%), cachexia (12.9%), diseases of the circulatory system (10.3%), conditions due to alcohol use (8.4%), septicemias (7.2%) and malnutrition (7.1%). Tuberculosis occurred as an associated cause in another 1,388 deaths. The mortality rate including TB as a both underlying and associated cause was 8.9/100,000 population, practically twice the classical rate. Deaths whose associated cause was reported as being TB had as underlying causes: AIDS (65.3%), diseases of the circulatory system (8.9%), neoplasms (7.5%), and diseases of the digestive system (4.8%). Clinical forms of nervous system and miliary TB were more frequent as a cause associated with AIDS than with other underlying causes (p<0,001). CONCLUSIONS Total reports of TB-related death practically doubled its mortality rate as an underlying cause. The increase in TB mortality was demonstrated to be influenced by the AIDS epidemic.

Mortalidade por tuberculose e indicadores sociais no município do Rio de Janeiro

Este artigo estuda a mortalidade por tuberculose no municipio do Rio de Janeiro ocorrida no ano de 1991 em comparacao com indicadores sociais. Utilizou-se o software SPSS 8.0 - 1997 na analise estatistica dos dados, que mostrou a existencia de correlacao entre a maioria dos indicadores socioeconomicos estudados e o coeficiente de mortalidade por tuberculose por 100 mil habitantes/ano. Apresentaram correlacao significativa e direta os indicadores: indice de Robin Hood, razao de renda entre os 10% mais ricos e os 40% mais pobres e proporcao de chefes de familia com renda media entre um e dois salarios minimos. A correlacao foi inversa e significativa com os indicadores: proporcao de residentes com mais de 10 anos com curso superior, area media por domicilio, numero de comodos por domicilio, renda media em salarios minimos, e proporcao de chefes de familia com rendas entre 10-15, 16-20 e acima de 20 salarios minimos. Para a apresentacao destes indicadores usou-se mapas do municipio, categorizados e distribuidos por Regioes Administrativas, revelando distintos Rios de Janeiro, quando este e visto sob o ângulo social: da doenca, ou de varios outros indicadores.

Prevalência de tabagismo em localidade urbana da região sudeste do Brasil

A cross-sectional study for prevalence of arterial hipertension in the population aged 15-74 years of age of the urban area of Araraquara County, 250 km from the city of S. Paulo, S. Paulo, State, Brazil, in 1987, was performed. The questionnaires presented to 1,199 people (533 men and 666 women) at the interview consisted of regarding sociodemographic variables, as well as the use of tobacco (smoking), the ways in which tobacco was used and the habit of inhaling the smoke. The sample was taken by the procedure of clustering, carried out in three stages. The sample was equiprobabilistic. The prevalence of tobacco smoking was very high being of 45.2% for men and 22.8% for women. The ex-smokers accounted for 15.9% of men and 8.0% of women. The men somked much more than the women. The poorer smoked more than the richer, in both sexes. Among men, the prevalence of smoking was inversely proportional to duration of schooling, but that difference was not noted in women. As there have been other studies regarding the high prevalence of obesity and high blood pressure, it was conluded therefore that the population of Araraquara, an average town of the affluent urban interior of S. Paulo State, has a high frequency of risk factors for chronic non-transmissible diseases.Foi realizado estudo transversal de prevalencia da hipertensao arterial da populacao de 15-74 anos de idade, residente na zona urbana do Municipio de Araraquara, localidade situada a 250 km da cidade de Sao Paulo, Estado de Sao Paulo, Brasil, em 1987. Na ocasiao foram perguntadas aos 1.199 entrevistados (533 do sexo masculino e 666 do sexo feminino) questoes sobre o uso de tabaco (fumo), a forma de uso, o habito de tragar, bem como variaveis sociodemograficas. A amostra foi equiprobabilistica, por conglomerados, em tres estagios. A prevalencia de tabagismo foi bastante alta, de 45,2% entre os homens e 22,8% entre as mulheres. Os ex-fumantes eram em percentagem de 15,9% entre os homens e 8,0% das mulheres. O sexo masculino fumava maior quantidade de equivalentes de cigarro do que o feminino. As camadas de mais baixa renda familiar fumavam mais, em ambos os sexos, do que os estratos de renda mais alta. Entre os homens, a prevalencia de tabagismo diminuia com a maior escolaridade e nas mulheres, este aspecto nao foi notado. Comparando com os resultados ja publicados sobre a alta prevalencia de hipertensao arterial e de obesidade, nota-se que a populacao de Araraquara, cidade media do interior urbano afluente do Brasil, apresenta uma frequencia bastante alta de fatores de risco para doencas cronicas nao-transmissiveis.A cross-sectional study for prevalence of arterial hypertension in the population aged 15-74 years of age of the urban area of Araraquara County, 250 km from the city of S. Paulo, S. Paulo, State, Brazil, in 1987, was performed. The questionnaires presented to 1,199 people (533 men and 666 women) at the interview consisted of regarding sociodemographic variables, as well as the use of tobacco (smoking), the ways in which tobacco was used and the habit of inhaling the smoke. The sample was taken by the procedure of clustering, carried out in three stages. The sample was equiprobabilistic. The prevalence of tobacco smoking was very high being of 45.2% for men and 22.8% for women. The ex-smokers accounted for 15.9% of men and 8.0% of women. The men smoked much more than the women. The poorer smoked more than the richer, in both sexes. Among men, the prevalence of smoking was inversely proportional to duration of schooling, but that difference was not noted in women. As there have been other studies regarding the high prevalence of obesity and high blood pressure, it was concluded therefore that the population of Araraquara, an average town of the affluent urban interior of S. Paulo State, has a high frequency of risk factors for chronic non-transmissible diseases.

Mortalidade de mulheres em idade fértil no Município de São Paulo (Brasil), 1986: I - Metodologia e resultados gerais

The purpose of this study was to evaluate the accuracy of the death certificates of a sample of a quarter of all deaths in women of reproductive age (10-49 years) resident in the Municipality of S. Paulo, SP, Brazil, in 1986. For each death, further data were gathered by means of household interviews and from medical records and autopsy information where available. Nine hundred and fifty-three deaths were analysed, for whom there were good quality death certificates except with regard to maternal deaths an terminal respiratory diseases, the former being greatly under-reported. The official maternal mortality rate was 44.5 per 100,000 live births but the true rate was 99.6 per 100,000 live births. The three main causes of death were cardiovascular diseases, neoplasms and external causes. A great proportion of smokers was found among the deceased women (40.4%). Eleven percent of the deceased consumed large amounts of alcoholic beverages regularly.Foi feita uma investigacao da fidedignidade das declaracoes de obito referentes a uma amostra de um quarto dos obitos de mulheres em idade fertil (10-49 anos) residentes no Municipio de Sao Paulo, SP, Brasil, em 1986. Foram obtidos para cada obito dados complementares atraves de entrevista domiciliar e revisao de prontuarios e de laudos de necropsia quando existentes. Foram estudados 953 casos que evidenciaram um bom preenchimento das declaracoes exceto para causas maternas e para afeccoes respiratorias terminais, as primeiras grandemente subenumeradas. O coeficiente de mortalidade materna oficial era de 44,5 por 100.000 nascidos vivos (NV) e o verdadeiro foi de 99,6 por 100.000 NV. As tres primeiras causas de morte eram, em ordem decrescente de importância, as doencas do aparelho circulatorio, os neoplasmas e as causas externas. Uma proporcao de 40,47% de mulheres falecidas fumava e outra, de 11,0% ingeria regularmente grande quantidade de bebidas alcoolicas.The purpose of this study was to evaluate the accuracy of the death certificates of a sample of a quarter of all deaths in women of reproductive age (10-49 years) resident in the Municipality of S. Paulo, SP, Brazil, in 1986. For each death, further data were gathered by means of household interviews and from medical records and autopsy information where available. Nine hundred and fifty-three deaths were analysed, for whom there were good quality death certificates except with regard to maternal deaths an terminal respiratory diseases, the former being greatly under-reported. The official maternal mortality rate was 44.5 per 100,000 live births but the true rate was 99.6 per 100,000 live births. The three main causes of death were cardiovascular diseases, neoplasms and external causes. A great proportion of smokers was found among the deceased women (40.4%). Eleven percent of the deceased consumed large amounts of alcoholic beverages regularly.

Multiple causes- of-death tabulator

O uso de causas multiplas de morte vem sendo atualmente preconizado para descrever e analisar os determinantes patologicos da mortalidade em populacoes, como complemento ao uso tradicional da causa basica de morte. O estudo das causas multiplas pode realizar-se por meio da apresentacao de todas as mencoes das causas basicas e associadas de morte e por meio de associacoes de causas. Um programa para microcomputador foi desenvolvido para processar bancos de dados contendo as causas de morte informadas no Modelo Internacional de Atestado Medico de Causa de Morte, denominado Tabulador de Causas Multiplas, que gera uma tabela matriz a partir da qual podem ser derivadas as demais formas de apresentacao e analise, alem de poder ser usado como instrumento de critica dos dados de mortalidade.

Tendência da mortalidade relacionada à doença de Chagas, Estado de São Paulo, Brasil, 1985 a 2006: estudo usando causas múltiplas de morte

OBJETIVO: Estudar a tendencia da mortalidade relacionada a doenca de Chagas informada em qualquer linha ou parte do atestado medico da declaracao de obito. METODOS: Os dados provieram dos bancos de causas multiplas de morte da Fundacao Sistema Estadual de Analise de Dados de Sao Paulo (SEADE) entre 1985 e 2006. As causas de morte foram caracterizadas como basicas, associadas (nao-basicas) e total de suas mencoes. RESULTADOS: No periodo de 22 anos, ocorreram 40 002 obitos relacionados a doenca de Chagas, dos quais 34 917 (87,29%) como causa basica e 5 085 (12,71%) como causa associada. Foi observado um declinio de 56,07% do coeficiente de mortalidade pela causa basica e estabilidade pela causa associada. O numero de obitos foi 44,5% maior entre os homens em relacao as mulheres. O fato de 83,5% dos obitos terem ocorrido a partir dos 45 anos de idade revela um efeito de coorte. As principais causas associadas da doenca de Chagas como causa basica foram as complicacoes diretas do comprometimento cardiaco, como transtornos da conducao, arritmias e insuficiencia cardiaca. Para a doenca de Chagas como causa associada, foram identificadas como causas basicas as doencas isquemicas do coracao, as doencas cerebrovasculares e as neoplasias. CONCLUSOES: Para o total de suas mencoes, verificou-se uma queda do coeficiente de mortalidade de 51,34%, ao passo que a queda no numero de obitos foi de apenas 5,91%, tendo sido menor entre as mulheres, com um deslocamento das mortes para as idades mais avancadas. A metodologia das causas multiplas de morte contribuiu para ampliar o conhecimento da historia natural da doenca de Chagas.

Causas básicas e associadas de morte por Aids, Estado de São Paulo, Brasil, 1998

OBJECTIVES To describe the Aids mortality according to its underlying and associated causes of death in the State of S. Paulo in 1998. METHODS Mortality and population data for 1998 were obtained from the State Data Analysis System Department (Fundação Sistema Estadual de Análise de Dados - Seade). Causes of death were coded according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems. RESULTS Aids was the underlying cause in 4,619 deaths, corresponding to the 10th leading cause of death (2.0%) and a mortality rate of 13.1/100,000 population. Male/female death ratio and rate ratios were respectively 2.4 and 2.5. Aids was the second leading cause of death among men aged 20--34 and women aged 25--34 years. Median age at death for women (34.1+/-12.2 years old) was lower than men (36.4+/-10.7 years old) - p<0,001. The main associated causes of Aids deaths were respiratory insufficiency (36.1%), pneumonia (27.0%), tuberculosis (19.6%), septicemia (18.6%), toxoplasmosis (12.2%), P. carinii pneumonia (8.3%) and cachexia (7.9%). Aids was an associated cause of death in additional 84 cases. The main underlying causes of these deaths were malignant neoplasms (28/84), conditions secondary to alcohol abuse (23/84) and diabetes mellitus (7/84). The median age at death due to Aids as an underlying cause (35.7+/-11.2 years old) was lower than the age at death with Aids as an associated cause (39.9+/-11.8 years old - p<0.001). CONCLUSIONS Multiple causes of death allow to track part of the Aids natural history and provide additional data to develop adequate and specific preventive actions.OBJECTIVES: To describe the Aids mortality according to its underlying and associated causes of death in the State of S. Paulo in 1998. METHODS: Mortality and population data for 1998 were obtained from the State Data Analysis System Department (Fundacao Sistema Estadual de Analise de Dados - Seade). Causes of death were coded according to the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems. RESULTS: Aids was the underlying cause in 4,619 deaths, corresponding to the 10th leading cause of death (2.0%) and a mortality rate of 13.1/100,000 population. Male/female death ratio and rate ratios were respectively 2.4 and 2.5. Aids was the second leading cause of death among men aged 20¾34 and women aged 25¾34 years. Median age at death for women (34.1±12.2 years old) was lower than men (36.4±10.7 years old) ¾ p<0,001. The main associated causes of Aids deaths were respiratory insufficiency (36.1%), pneumonia (27.0%), tuberculosis (19.6%), septicemia (18.6%), toxoplasmosis (12.2%), P. carinii pneumonia (8.3%) and cachexia (7.9%). Aids was an associated cause of death in additional 84 cases. The main underlying causes of these deaths were malignant neoplasms (28/84), conditions secondary to alcohol abuse (23/84) and diabetes mellitus (7/84). The median age at death due to Aids as an underlying cause (35.7±11.2 years old) was lower than the age at death with Aids as an associated cause (39.9±11.8 years old ¾ p<0.001). CONCLUSIONS: Multiple causes of death allow to track part of the Aids natural history and provide additional data to develop adequate and specific preventive actions.